School of Nursing. University of Miami ..... study had already enrolled in a practical nursing school when ... the Unive
MATERNAL-CHILD HEALTH AND GANJA IN JAMAICA
MELANIE C. DREHER School of Nursing University of Miami Until quite recently, marihuana smoking has been, almost universally, a male-dominated activity. Ethnographic studies of cannabis use in non-Western cultures (Rubin 1975; Rubin and Comitas 1975; Carter, Coggins and Doughty 1976; Soueif 1976; Hamid 1980; Dreher 1981, 1982). as well as survey findings in Britain and North America (Evans, Stevens and Samuel 1974; Roseberg, Kase and Berberian 1974; Blackford 1973; Galli 1974; Abelson and Fishburne 1976; Johnston, Backman and O'Malley 1977; Linder, Lerner and Burke 1974; Pandian 1977; Kandel, Single and Kessler 1976 J. document that historically men have been likely to smoke marihuana sooner, more frequently and longer than women. The early anthropological studies in Jamaica, as well, focused on cannabis, or "ganja", smoking as a working-class, male social activity (Rubin and Comitas 1975; Dreher 1982). At that time, the female cannabis smoker was rare (particularly in rural communities), and even those women who CUltivated and sold marihuana refrained from smoking the substance. Instead, they prepared and consumed it in teas or "tonics" , a form of consumption which crossed the socioeconomic, age, and sex lines which ordinarily guide the normative use of cannabis in Jamaica.
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Now. even to th~ C:Jsual obse,-ver, it is obvious that more and mort! women have begun to smoke g.mja in a manner not unlike that of men. Estimates gi v en by informants of the proportion of women in their rural communities smoking ganja ranged from 15 to SO percent with the majority hovering ar-ound the hi g her figure (Shapiro 19B3J . Moreover, many women 3re smoking gao;a throughout pregnancy . during labor. and into the breast-feeding perio d. As the use of ganja continues to incr-ease among women of childbearing age, the extent to which this constitutes a public health problem in Jamaica is still undetermined. In Jamaica. as in North Americ:J. c igarettes. alcohol, and marihuana are the most c ommonly used drugs during pregnancy . The deleterious effects of alcohol and cigarettes on the fetus and newborn have been well substanti~ ated. In compari s on. s tudies on tMe consumption of m;arihuana and its deriv;ati v es during pregnanc.y and the lactation period are r l!iativeiy f ew even though it is now known t hat THe (tetrahydrocannibinol J crosses the placenta barrier and has been traced in the mammary glands and milk of lactating women.
s moking through interviews and direct o bserv ation in c ommunity-based field sites .
Medical research on perinatal cannabis use has been designed to inves tigate the possib le harmful effects of c annabis smoking during pregnancy on the mother or infant. I ncluded in this res earch are studies linking cannab is use to neurological abnormalities (Fried 19801. maternal weight gain. duration and progress of labor, meconium stain ing ( Green land et al. 1982), major malformations. length of gestation and Jow birth weight (Hingson et al. 1982; Linn et al. 19831. The results of these studies. however. ha v e been largely inconclusive and often conflicting. primarily because of the inability to control for and explain s ocioeconomic and c ontextual variables. The marihuana users in these studies generally have lower incomes and educat io n. are more likely to repres ent a minority culture and consume more a lcohol and tobacco. and have poorer health habits than non-users; co nsequently it is difficult to di s t inguish the effects of c annabis from the many otht!:r variables that could influence tht!: outcome of pregnancy. Clearly. clinical findings are extremely difficult to understand unless they are interpreted in relation to other lifestyle c h aracteristics of the subjects. Yet there are s till no published studies that have examined patterns of perinatal marihuana use and subsequent neonat
